Brunei Darussalam Elsewhere Brunei Int Med J. 2015; 11 … 2015 Volume 11, Issue...

Brunei Darussalam Elsewhere Brunei Int Med J. 2015; 11 (2): 123-125

This sec�on of the journal serves to highlight the works and researches done by local doctors or doctors either

in Brunei Darussalam or in collabora�ons with other centres that have been published in regional or interna-

�onal journals. This also includes works published as part of collabora�on with centres outside of Brunei Da-

russalam. These works include review ar�cles, original ar�cles and case reports published between 15th

De-

cember 2014 to 14th April 2015. (Some publica�ons have been published or indexed at a later date a)er publi-

ca�on ahead of print).

Overexpression of EGFR protein in

Bruneian lung cancer patients.

Han YH, Abdul Hamid MR, Telisinghe PU, Haji

Hussin JB, Mabruk M.

Asian Pac J Cancer Prev. 2015;16(1):233-7.

ABSTRACT

BACKGROUND: Lung cancer is the leading cause

of cancer death in Brunei Darussalam, accounting

for almost 20% of the total. The epidermal growth

factor receptor (EGFR) is a member of the erbB

family of tyrosine kinase receptor proteins, which

includes c-erbb2 (HER2/neu), erb-B3, and erb-B4.

EGFR overexpression is found in a third of all epi-

thelial cancers, often associated with a poor prog-

nosis.

MATERIALS AND METHODS: Protein expression

of EGFR in 27 cases of lung cancer tissue samples

and 9 cases of normal lung tissue samples was

evaluated using an immunohistochemical approach.

RESULTS: The results demonstrated significant

increase and overexpression of EGFR in Bruneian

lung cancer tissue samples in comparison to normal

lung tissue. However, there was no significant rela-

tionship between clinicopathologic variables (age

and sex) of patients and EGFR protein expression.

CONCLUSIONS: EGFR is overexpressed in Bru-

neian lung cancer patient tissue samples in com-

parison to normal lung tissue samples. This may

indicate that EGFR protein over expression plays an

important role in the genesis of this type of cancer

in Brunei Darussalam.

Correspondence: Prof M Mabruk. PAPRSP Institute of

Health Sciences, University of Brunei Darussalam, Gadong,

Brunei Darussalam

E mail:[email protected]

or [email protected].

Lee SM, Lim LC, Koh D.

Occup Med (Lond). 2015 Jan;65(1):67-71.

BACKGROUND: Stigma among sufferers of chronic

diseases such as obesity, human immunodeficiency

virus disease and mental health disorders has been

studied. This study addresses stigma affecting

workers with diabetes.

AIMS: To investigate diabetes-related stigma and

associated factors in a group of workers receiving

care in a Singapore diabetes outpatient clinic.

METHODS: Type 2 diabetes mellitus (T2DM) pa-

tients receiving subsidized care and holding full-

time employment were consecutively recruited over

9 months. A questionnaire was individually admin-

istered by an interviewer.

RESULTS: One hundred and twenty-five partici-

pants were recruited. Fifteen, who reported experi-

encing stigma, had higher median hospitalizations

compared with the rest of the study group (2

(interquartile range (IQR) 0-6) versus 0 (0-1.75), P

< 0.05). They were more likely to report that their

diabetes affected work (8 (53%) versus 25 (23%),

P < 0.05); having heard others experience diabetes

-related stigma (9 (60%) versus 33 (30%), P <

0.05) and that employment prospects were affect-

ed (6 (40%) versus 18 (16%), P < 0.05), as well

as having higher HbA1c (9.5% versus 8.5%, P >

0.05). Fifty-three per cent (66) of respondents re-

ported that work affected their diabetes. There was

no significant difference between the stigma and

non-stigma groups in age (mean 50 years), body

mass index (BMI; mean 28kg/m(2)), diabetes du-

ration (12 years) and insulin use.

CONCLUSIONS: Twelve percentage of employed

T2DM outpatients reported experiencing stigma

because of diabetes. This was associated with fre-

quency of hospitalization (a surrogate for poorer

health) and poorer diabetes control. Strategies to

reduce stigma include optimizing diabetes control,

patient support and educating employers to im-

prove understanding of diabetes and its work impli-

cations.

Stigma among workers attending a

hospital specialist diabetes clinic.

Stigma among workers attending a

hospital specialist diabetes clinic.

Correspondence: Prof David Koh. Saw Swee Hock School

of Public Health, National University of Singapore, S119077

Singapore, PAPRSB Institute of Health Sciences, Universiti

Brunei Darussalam Jalan Tungku Link, Gadong, BE 1410,

Brunei Darussalam.

Note: Work done in oversea centre.

Extrahepatic biliary cystadenoma: a

rare cause of biliary obstruction.

Metussin A, Telisinghe P, Kok K, Chong V.

Oman Med J. 2015 Jan;30(1):66-8.

ABSTRACT

Biliary cystadenoma is a rare tumor of the biliary

tree and a rare cause of obstructive jaundice. Most

are intrahepatic, and pure extrahepatic biliary

cystadenoma is less common. Cases are more com-

mon in women. Unless suspected, diagnosis of ex-

trahepatic biliary cystadenoma is often delayed.

Here, we report the case of a young woman with

extrahepatic biliary cystadenoma who presented at

Raja Isteri Pengiran Anak Saleha Hospital with ob-

structive jaundice initially thought to be due to a

large biliary stone based on the endoscopic cholan-

giogram image. She was successfully managed

with resection of the cystadenoma.

Correspondence: Chong VH. Department of Medicine,

RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei

Darussalam. E mail: [email protected]

Ectopic Inferior Vena Cava Thrombus

Secondary to a Tubo-Ovarian

Abscess.

Koh KS, Abdullah NA, Chong VH.

Med J Malaysia. 2014 Dec;69(6):293-295.

ABSTRACT

Inferior vena cava (IVC) thrombosis typically arises

distally from a thrombophlebitic extension in the

pelvis or the lower extremities. It may also occur

from propagation of an ovarian vein thrombosis as

a result of gynaecological disorders such as pelvic

inflammatory disease, endometritis or from pelvic

surgeries. In this report, we present an interesting

case of a tubo-ovarian abscess with an ectopic IVC

thrombus. The approach to management in such

cases is also highlighted.

Correspondence: Koh Kai Shing. Department of Surgery,



Brunei Darussalam Elsewhere Brunei Int Med J. 2015; 11 (2): 124

Rectal bleeding from seeds impac-

tion.

Metussin A, Mohamad MZ, Chong VH.

Turk J Gastroenterol. 2014 Dec;25(Suppl 1):S270-

S271.

NO ABSTRACT




Urogenital Melioidosis: A Review of

Clinical Presentations, Characteristic

and Outcomes.

Chong VH, Sharif F, Bickle I.

Med J Malaysia. 2014 Dec;69(6):257-260.

ABSTRACT

INTRODUCTION: Melioidosis is endemic to the

tropical regions, in particular Thailand and Northern

Australia. Any organ can be affected by melioidosis.

Involvement of the urogenital system is common in

Northern Australia, but is less common in other

regions. This study assesses the characteristics of

melioidosis affecting the urogenital system treated

in a tertiary referral centre in Brunei Darussalam.

MATERIAL AND METHODS: All patients treated

for melioidosis of the urogenital system were iden-

tified and retrospectively reviewed.

RESULTS: There were 9 patients with 11 episodes

of urogenital infections treated over 13 years. The

median age at diagnosis was 38 years old (range

29 - 63) with men predominantly affected. The

major risk factor was underlying diabetes mellitus

(n=9), including three patients diagnosed at the

time of diagnosis of melioidosis. The median glyco-

sylated haemoglobin (HbA1c) was 12.8% (range

6.4 to 16.6%). One patient's risk factor was only

moderate alcohol consumption. Common symptoms

included; fever, lethargy, rigor and anorexia. Dysu-

ria was reported by two patients. The median dura-

tion of symptoms before presentation was 7 days

(range 2 to 21 days) and the median number of

sites involved were 3 (range of 2 to 6). Urogenital

involvement included prostate (n=6), kidney

(n=8), seminal vesicles (n=1) and testis (n=1).

Radiological imaging showed that large prostate

abscesses (>4.5cm) were common, and in some

patients, the kidney abscess had the 'honeycomb'

previously described as typical for melioidosis liver

abscess. All patients were successfully treated for

melioidosis and at a median follow up of 34 months

(range 1 - 97), there was one death from complica-

tions of diabetes mellitus.

CONCLUSION: Urogenital melioidosis only ac-

counted for a small proportion of all melioidosis

involvement, with prostate and kidney most com-

monly affected. Concomitant involvement of other

sites were common. The major risk factor was

poorly controlled diabetes mellitus.




A proposal for a CT driven classifica-

tion of left colon acute diverticulitis.

Sartelli M, Moore FA, Ansaloni L, Di Saverio S, Coc-

colini F, Griffiths EA, Coimbra R, Agresta F, Sakaku-

shev B, Ordoñez CA, Abu-Zidan FM, Karamarkovic

A, Augustin G, Costa Navarro D, Ulrych J, Deme-

trashvili Z, Melo RB, Marwah S, Zachariah SK, Wani

I, Shelat VG, Kim JI, McFarlane M, Pintar T, Rems

M, Bala M, Ben-Ishay O, Gomes CA, Faro MP, Perei-

ra GA Jr, Catani M, Baiocchi G, Bini R, Anania G,

Negoi I, Kecbaja Z, Omari AH, Cui Y, Kenig J, Sato

N, Vereczkei A, Skrovina M, Das K, Bellanova G, Di

Carlo I, Segovia Lohse HA, Kong V, Kok KY, Massa-

lou D, Smirnov D, Gachabayov M, Gkiokas G, Ma-

rinis A, Spyropoulos C, Nikolopoulos I, Bouliaris K,

Tepp J, Lohsiriwat V, Çolak E, Isik A, Rios-Cruz D,

Soto R, Abbas A, Tranà C, Caproli E, Soldatenkova

D, Corcione F, Piazza D, Catena F.

World J Emerg Surg. 2015 Feb 19;10:3. doi:

10.1186/1749-7922-10-3. eCollection 2015. Re-

view.

ABSTRACT

Computed tomography (CT) imaging is the most

appropriate diagnostic tool to confirm suspected

left colonic diverticulitis. However, the utility of CT

imaging goes beyond accurate diagnosis of divertic-

ulitis; the grade of severity on CT imaging may

drive treatment planning of patients presenting

with acute diverticulitis. The appropriate manage-

ment of left colon acute diverticulitis remains still

debated because of the vast spectrum of clinical

presentations and different approaches to treat-

ment proposed. The authors present a new simple

classification system based on both CT scan results

driving decisions making management of acute

diverticulitis that may be universally accepted for

day to day practice.

Brunei Int Med J. 2015; 11 (2): 125

NOTE: Collaboration between Kok KY with external centres

Text is freely available from journal website at http://

www.wjes.org/content/1749-7922/10/3

Early experience with attain stabil-

ity, an activefixation LV lead: virtues

and pitfalls.

Johar S, Luqman N.

Pacing Clin Electrophysiol. 2015 Mar;38(3):297-

301.

ABSTRACT

Background: Appropriate left ventricle (LV) lead

placement is integral to successful cardiac resyn-

chronization therapy (CRT). Lead dislodgement and

phrenic nerve stimulation (PNS) are major obsta-

cles. A recent trial of an active fixation LV lead

(Attain Stability 20066, Medtronic Inc., Tilburg, the

Netherlands) has shown promising results. We

share our initial experience with this novel active

fixation LV lead.

METHODS: A Medtronic active fixation lead 20066

was used in eight consecutive patients for CRT. An

optimal site was chosen and recommended maneu-

vers were applied for lead fixation. Push and pull

maneuvers were used to test stability.

RESULTS: There were two initial dislodgements

after which we used a transvalvular insertion (TVI)

tool that was used in the hemostatic valve during

rotation of the lead so that the torque was easily

transmitted to the tip. It also allowed better tactile

feedback during push-pull tests. There were no

further dislodgements in the subsequent six pa-

tients. However, in one patient the lead could not

be unscrewed due to the tip getting wedged at a

distal smaller vein. Repositioning of the LV lead was

done in three patients due to PNS or pacing issues.

The median time for LV lead placement was 16.5

minutes (interquartile range 9-25 minutes).

CONCLUSION: The Medtronic Attain Stability

20066 active fixation LV lead can potentially be

implanted at any pacing site avoiding PNS and

providing better stability. The learning curve is

short and additional tricks can be learnt to improve

success. Use of TVI while the lead is rotated is ben-

eficial.

Correspondence: Sofian JOHAR. Department of Cardiolo-

gy, RIPAS Hospital, Bandar Seri Begawan, Brunei Darus-

salam; Cardiac Center, Gleneagles Jerudong Park Medical

Center, Bandar Seri Begawan, Brunei Darussalam.

E mail: [email protected]

Volume 11, Issue 3 15 June 2015 (26 Jamadil-Akhir 1436H )

Brunei International

Medical Journal OFFICIAL PUBLICATION OF

THE MINISTRY OF HEALTH,

BRUNEI DARUSSALAM

ISSN 1560 5876 Print

ISSN 2079 3146 Online Online version of the journal is available at www.bimjonline.com

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